Geriatrics Part 2 Flashcards
when pharmacokinetic changes do not explain alterations to a drug response in a geriatric patient, what changes are assumed?
pharmacodynamic changes
which changes with aging are better understood – pharmacokinetics or dynamics?
pharmacokinetic changes are better understood
which are more VARIABLE -pharmacokinetic or dynamic changes with age?
explain
pharmacodynamic changes are more variable
changes in the:
-number of receptors
-sensitivity of receptors
-counter regulatory mechanisms
give an example of drug receptors that INCREASE sensitivity with age
benzodiazepines and CNS depressants
give an example of drug receptors that DECREASE sensitivity with age
beta-adrenergic receptors
geriatrics have _____ baroreceptor sensitivity
explain
decreased
leads to orthostatic hypotension - low Bp when standing and baroreceptors are not as sensitive - increases fall risk
name 3 drugs that can enhance the issue of orthostatic hypotension in elderly patients
tricyclic antidepressants
vasodilators
antihypertensives
antipsychotics in elderly patients increases the risk of what?
is this a pharmacokinetic or dynamic effect?
increased risk of tardive dyskinesia and parkinsonism (rapid sudden movements)
pharmacodynamic
true or false
elderly patients have a decreased sensitivity to anticholinergic effects
FALSE - increased sensitivity
elderly patients have ____ sensitivity to warfarin
increased (bc less albumin - more free drug)
true or false
geriatrics have increased sensitivity of Na+, K+, ATPase
true
leads to increased toxicity to digoxin especially with low potassium
explain the elderly response to ACE inhibitors and ARBS (angiotensin receptor blockers)
decreased response to them bc of decreased renin and aldosterone levels
geriatrics have an increased risk of hyperkalemia with what drugs?
NSAIDS
ACE inhibitors and ARBS (bc decreased response to them)
potassium sparing diuretics (spiranolactone)
explain how evidence-based prescribing is an important consideration in the older population
need to see what research has been done on the very old
not a lot of clinical trials on very old people
what is the saying for dosing an elderly patient on medication
start low, go slow, but don’t stop too soon
a specific issue in older adults is whether or not we should bother treating a certain condition
give an example of this
treating dyslipedemia (high cholesterol) for primary prevention
name 2 diseases that we treat less intensively in older adults
diabetes - don’t NEED below 7 A1C
hypertension - don’t treat too much - risk of orthostatic hypotension and falls
as time goes on, care changes from ____ to ____
curative to palliative
as care changes from curative to palliative, what happens to the amount of appropriate medications?
decreases
_______ side effects are of particular concern in the elderly
anticholinergic
what is the AGS Beers Criteria?
a list of potentially inappropriate medications for use in older adults
how many tables are in the 2023 updated Beers Criteria?
7
what medications are on table 2 in the Beers criteria
medications/classes that should be AVOIDED in persons 65 or older
what medications are on table 3 of the beers criteria
meds that should be avoided in older person with specific disease/syndrome
drug-disease interactions
what meds are on table 4 of beers criteria
meds that should be used with CAUTION in older adults
not enough info to be put on 2 or 3, but on radar
what meds are on table 5 of beers criteria
potential important drug-drug interactions to avoid in geriatrics
what meds are on table 6 of beers criteria
meds that should be avoided/lower dose in older people with decreased renal function
what is on table 7 of beers criteria
meds with strong anticholinergic properties
what is the fall risk factor that is most preventable and reversible?
medication use
why are alpha blockers avoided in elderly?
name 2
increases fall risk
terazosin and doxasozin
true or false
diuretics can increase fall risk
true - have to pee more, have to stand up fast, run to bathroom and fall
____ or more CNS depressants can increase fall risk
3
can antidepressants increase fall risk
yes
say the pneumonic to remember anticholinergic side effects
dry as a bone
dry eyes, mouth
full as a flask
constipation, urinary retention
blind as a bat
mad as a hatter
delirium
tachycardia
what can drugs with anticholinergic side effects do to heart rate
increase
name 3 classes of drugs with strong anticholinergic properties
what Beers table are they on?
table 7
1st generation antihistamines (anything “pm” in OTC aisle)
phenothiazines
tricyclic antidepressants
name 3 skin and connective tissue diseases commonly seen in geriatrics
arthritis
gout
glaucoma
which type of arthritis is most common in older adults?
osteoarthritis
rheumatoid starts younger and is more systemic
how are medications related to arthritis?
NSAIDS and opioids can cause/worsen arthritis in elderly patients
that’s why diclofenac is preferred as an NSAID bc it has no systemic side effects when applied topically
when an elderly patient has gout, what is an important consideration?
possible renal issues
name an issue with antibiotics in older adults
renal function is a big consideration in antibiotics renally excreted
name the 3 most common infections in geriatrics
UTI
pneumonia
skin infections
what symptoms may a geriatric patient experience when they have a UTI?
atypical symptoms like confusion and falls
their sensation for burning is not as strong
what symptoms may a geriatric patient experience when they have pneumonia?
not typical symptoms like cough
may have similar to UTI like confusion and falls
why are skin infections 1 of the 3 most common infections in geriatrics
elderly have thin skin
what is the GOAL blood pressure for geriatric patients
why?
130/80
or less than 130, but not too low - concern with orthostatic hypotension
what blood pressure medications should be avoided in geriatrics and why
alpha blockers - fall risk (terazosin/doxasozin)
beta blockers (for LONE htn) can be used if for afib
name 4 favored agents for HTN for older adults
low dose diuretics
ACE inhibitors
ARBS
ca channel blockers (amlodipine)
what is a side effect of calcium channel blockers that is a concern with the elderly
ankle swelling
what is the most costly medicare diagnosis in the US
heart failure
explain the treatment guidelines for heart failure for elderly patients vs younger patients
essentially the same - want to balance fluid overload vs dehydration
in treating a heart failure patient, what are important things to monitor?
renal function and potassium levels
what is a drug that is not 1st line for HTN
digoxin
have to monitor for toxicity - especially if low potassium - binds to same receptors
visual changes, nausea, anorexia, confusion
true or false
digoxin is renally eliminated
true
true or false
anticoagulants are contraindicated in the elderly
FALSE - age is not a contraindication
in afib, an important consideration is controlling ____ vs controlling ____
rate vs rhythm
in AFIB patients, anticoagulants are used to prevent stroke
which drugs are preferred
DOACS (direct oral anticoagulants) over warfarin
why is treating dyslipidemia not really done in the elderly
few studies
risk-benefit for primary prevention: side effect of statins is muscle pain and this increases fall risk
true or false
aspirin should be avoided for primary prevention in people over 60
TRUE - not secondary prevention tho (already had heart attack/stroke)
risk for bleeding
